PubMed · 15997028
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David N Juurlink, Allan S Detsky. 2005-07-05. Kappa statistic.. https://doi.org/10.1503/cmaj.1041744
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Rasagiline (N-propargyl-1 (R)-aminoindan) is a selective, potent irreversible inhibitor of MAO-B that possesses neuroprotective and anti-apoptotic properties in a variety of in vitro and in vivo animal models relevant to Parkinson's disease (PD). Several randomized controlled clinical trials have demonstrated the safety and efficacy of rasagiline as monotherapy in PD and as adjunctive therapy for patients receiving levodopa. In addition, the 1-year randomized, delayed-start analysis of the TEMPO study suggests that rasagiline may slow the rate of progression of PD. The randomized delayed-start paradigm has potential to differentiate short-term symptomatic effects from long-term effects of anti-parkinsonian agents. In the future, long-term trials to examine the potential disease-modifying effects of rasagiline, which incorporate biological markers as well as clinical endpoints, may further elucidate the role of rasagiline in the treatment of both early and advanced PD.
STUDY DESIGN: Review and summary of the relevant literature from multiple disciplines. OBJECTIVE: Provide the readership with evidence-based guidelines on the initial assessment and treatment of the multiple-trauma patient with an associated spinal column injury. SUMMARY OF BACKGROUND DATA: Early operative stabilization of the isolated spinal column injury has decreased hospital and intensive care unit length of stay. Early intervention has not provided consistently improved neurologic outcomes. The timing of spinal column stabilization in the multiple-trauma patient continues to be a source of discussion. METHODS: Review of published English literature from 1990 to present using key words: spinal trauma, multiple-trauma with spinal injury; timing of spinal injury treatment; spinal fracture management; and Advanced Trauma Life Support. CONCLUSIONS: The treatment of the poly-trauma patient with an associated spinal column injury requires strict adherence to Advanced Trauma Life Support principles. Once life and limb-threatening injuries have been identified and addressed, spinal column assessment and neurologic protection must be maintained at the highest priority. Early spinal stabilization can be performed safely in the multiple-trauma patient in medical centers, in which medical and ancillary staff is available on a 24-hour basis and is familiar with these procedures.
It is important that debate occurs between theorists, policy makers, clinicians and service end-users to develop agreement over suitable and appropriate indicators for primary health care. A formal accounting of the relative strengths and weaknesses of any proposed indicator will enable sector commentators from a variety of viewpoints to discuss the relative merits of individual indicators, to understand the political and pragmatic reasons for their inclusion in any set of indicators and to trace the likely organisational impact of any given indicator. This paper details the development of an indicator appraisal tool that combines the assessment of scientific evidence with contextual considerations from the perspective of both the policy environment and the primary health care sector. The use of the tool is discussed in the context of the proposed national implementation of a set of performance indicators in New Zealand.